CPT Coding for Converting to an Open approach

March 2, 2017

Question:
My doctor started a laparoscopic cholecystectomy that had to be converted to open due to significant adhesions. He documented both approaches and the laparoscopic approach took significant time before he had to convert to open. Can both be billed?

Answer:Unfortunately, no. Whenever a “closed” procedure (laparoscopic, arthroscopic, endovascular) is converted to an open procedure only the open procedure may be reported. If a significant amount of time was spent attempting the closed procedure, and this is documented, a 22 modifier for increased procedural services may be appended to the open code. Don’t forget to add the appropriate diagnostic code to indicate the conversion. See the appropriate diagnosis codes below:

Z53.31 Laparoscopic procedure converted to open

Z53.32 Thoracoscopic procedure converted to open

Z53.33 Arthroscopic procedure converted to open

Z53.39 Other specific procedure converted to open

*This response is based on the best information available as of 03/02/17.